Development of wearable
healthcare device
A user-centred project focused on meeting discovered needs of nurses
SANDRA BRANDER KARIN VON SCHEWEN STERNDAL
Master of Science Thesis Stockholm, Sweden 2014
Development of wearable healthcare device
-A user-centred project focused on meeting discovered needs of nurses
Sandra Brander
Karin von Schewen Sterndal
Master of Science Thesis MMK 2014:32 MCE 305 KTH Industrial Engineering and Management
Machine Design SE-100 44 STOCKHOLM
Master of Science Thesis MMK 2014:32 MCE 305
Development of wearable healthcare device -A user-centred project focused on meeting
discovered needs of nurses
Sandra Brander Karin von Schewen Sterndal
Approved
2014-06-11
Examiner
Sofia Ritzén
Supervisor
Jon Herman Rismoen
Commissioner
Tieto
Contact person
Cathrin Fogelberg
Abstract
The healthcare industry is highly information intense and is progressively adopting information technology (IT) systems. Despite large resources being invested in health information technology, a large percentage of healthcare personnel are dissatisfied with functionality and usability of the systems. One main issue is considered to be the low grade of user involvement in development of health information technology systems and products.
Tieto, the commissioner of the thesis project, develops IT systems for several different industries, amongst them is the healthcare industry. The purpose of the project was in collaboration with Tieto decided to be “By the use of a suitable development process; define work routine problems and potential improvements for nurses working at care units, and to develop a conceptual smart wearable device solving such a problem”.
The project was performed using a customised version of a spiral product development process, where different methods suitable for the project were integrated. A lot of focus was put on involving the user, nurses, in the development process and four different hospitals were visited to gather empirical results and to later validate findings and concepts.
The result of the thesis is the conceptual product ELSA, a wearable alarm system developed for nurses. The alarm differs significantly from alarm systems used in care units today and each nurse will wear an ELSA watch which can generate emergency alarms and assistance alarms. The ELSA watch also enables seeing alarms from any location in the care unit. By keeping the alarm buttons close at all times, time can be saved in emergent situations.
Examensarbete MMK 2014:32 MCE 305
Utveckling av bärbart verktyg för sjukvården -Ett användarcentrerat projekt fokuserat på att möta
upptäckta behov hos sjuksköterskor
Sandra Brander Karin von Schewen Sterndal
Godkänt
2014-06-11
Examinator
Sofia Ritzén
Handledare
Jon Herman Rismoen
Uppdragsgivare
Tieto
Kontaktperson
Cathrin Fogelberg
Sammanfattning
Sjukvården är som helhet en av de mest informationsintensiva brancherna och inför alltmer informationsteknologi (IT) system. Trots att stora resurser investeras i IT för vården så är en stor andel sjukvårdspersonal missnöjda med funktionalitet och användarvänlighet i dessa. En bidragande faktor tros vara den låga graden av användarinvolvering i utveckling av IT system och produkter för sjukvården.
Tieto, beställaren av examensprojektet, utvecklar IT-system för ett antal olika industrier, varav sjukvården är en. Syftet med projektet var tillsammans med Tieto satt till ”Med användandet av en passande utvecklingsprocess; definiera arbetsrelaterade problem och förbättringsmöjligheter för sjuksköterskor som arbetar på vårdavdelningar, och att utveckla ett koncept för ett smart bärbart verktyg som löser ett sådant problem”.
Projektet utfördes med en skräddarsydd version av en spiralformad produktutvecklingsprocess där olika metoder passande för projektet integrerades. Mycket fokus lades på att involvera användaren, sjuksköterskor, i utvecklingsprocessen och fyra olika sjukhus besöktes för att samla empiri och för att senare i processen även validera empiriska resultat och koncept.
Resultatet av examensarbetet är konceptet ELSA vilket är ett bärbart larmsystem utvecklat för sjuksköterskor. ELSA-systemet skiljer sig betydligt från de larmsystem som används på vårdavdelningar idag. Med ELSA-systemet förses varje sjuksköterska med en ELSA-klocka som kan generera akutlarm och assistanslarm men även ta emot larm från andra ELSA-klockor och patienter. ELSA-klockan bärs hela tiden med av sjuksköterskan vilket gör att möjligheten att larma alltid finns nära till hands.
P REFACE
The master thesis project was performed in collaboration with Tieto and the Royal Institute of Technology. The project is representative of the final course in the authors´ education within Integrated Product Development.
The authors would like to extend their most sincere gratitude towards the persons that have supported and helped the project. To our supervisor at Tieto, Cathrin Svensson, we would like to express our deepest appreciation for your constant flow of ideas and questioning of methods and ways of thinking. To our supervisor at the Royal Institute of Technology, Jon Herman Rismoen we would like to thank you for always giving us new perspectives of the project.
We would also like to thank the care units that have provided us with user aspects through participation in empirical research, and other persons involved in the project in different ways.
Linnea Källgård, Tieto Niklas Kvarnström, Tieto Esbjörn Blomquist, Tieto Jenny Janhager Stier, KTH
Department A23a, Karolinska sjukhuset Department 31, Danderyds sjukhus Department 111b, Gävle sjukhus Department 56, Södersjukhuset Department 34, Södersjukhuset
Sandra Brander Karin von Schewen Sterndal Stockholm, June 2014
N OMENCLATURE
This chapter aims to describe the abbreviations and healthcare vocabulary used in this Master thesis report.
Abbreviations
GPS Global Positioning System
HCI Human-Computer Interaction
HIT Health Information Technology
IoT Internet of Things
IR Infrared
IT Information Technology
NFC Near Field Communication
RFID Radio Frequency Identification
Vocabulary
Assistant nurse A nurse having gone through a one year education, or upper secondary school nursing education.
Care unit Part of the hospital where patients are hospitalised and cared for.
Medicine room Locked room at the care unit where medication is stored.
Medicine trolley Trolley with medications, a computer and more used by nurses.
Nurse watch Watch worn by the breast pocket of the nurse uniform.
Patient list The list used by nurses for taking notes and remembering.
Registered nurse A nurse having gone through the three year education.
Smart device Electronic device connected to other devices or networks usually via wireless communication technologies such as Bluetooth, RFID, NFC, Wifi, 3G etc.
T ABLE OF C ONTENTS
1. Introduction ... 1
1.1 Background ... 1
1.2 Purpose ... 2
1.3 Delimitations ... 2
2. Frame of reference ... 3
2.1 Product development ... 3
2.2 Information technology ... 8
2.3 Information technology within healthcare ... 10
3. Methodology ... 13
3.1 Planning ... 13
3.2 Empirical research... 14
3.3 Concept development ... 15
3.4 Testing and validation ... 16
4. Implementation ... 19
4.1 Literature study ... 19
4.2 Planning ... 19
4.3 Empirical research... 23
4.4 Iteration one ... 27
4.5 Iteration two ... 34
4.6 Iteration three ... 37
5. Results ... 43
5.1 The functions ... 43
5.2 Physical design ... 44
5.3 Interface design ... 46
5.4 Surrounding system ... 50
5.5 Technical solutions ... 51
5.6 Conceptual movie ... 54
5.7 Validation of the final concept ... 54
6. Discussion and conclusion ... 55
6.1 Discussion of methodology ... 55
6.2 Discussion of results... 56
6.1 Discussion of delimitations ... 58
6.2 Conclusions ... 59
7. Recommendations and future work ... 61
7.1 Recommendations ... 61
7.2 Future work ... 61
8. Bibliography ... 63
APPENDIX 1. Time plan APPENDIX 2. Risk analysis APPENDIX 3. Requirements
APPENDIX 4. Customer journey map APPENDIX 5. Interview guide
APPENDIX 6. Storyboards APPENDIX 7. Design evaluation APPENDIX 8. Interface design
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1. I NTRODUCTION
In the introduction chapter the background of the master thesis is presented, along with information about Tieto, the company that the thesis is written in collaboration with. The purpose and delimitations of the project are also presented.
1.1 Background
The healthcare sector is one of the most information intense industries existing. Therefore, the importance of achieving a proper information flow between actors such as doctors, nurses, patients and relatives is crucial for the efficiency and excellence of the area. Information technology (IT) is a natural solution for achieving proper information flow in the modern technology society. (Scandurra, 2013)
Adoption of information technology in healthcare has progressed rapidly during the last decade, which can be exemplified with that in 2005 only one Swedish county council had completely adopted IT-support for healthcare documentation and in 2012 all county councils in Sweden had fully adopted the support. IT-costs for Swedish county councils have also increased with 47%
between 2004 and 2011. (Jerlvall & Pehrsson, 2012) According to Dagens Medicin (2010), 32 billion SEK have been invested in health information technology between 2005 and 2010.
Despite the increased adoption and investments in health information technology, there is significant discontent in perception of the current health information technology. According to Vård-IT-rapporten (2010) 36 % of healthcare personnel were dissatisfied with development of the information technology systems used and 46% did not believe IT reduced stress in the work.
Several different approaches have previously been used when developing health IT systems, but the problem is believed to rise from not involving the end-user enough when developing new solutions. Scandurra (2013) claims that, in order to solve the problem with complicated information technology systems, health personnel need to be involved in the development.
Computers currently play an important role in the utilisation of IT in healthcare. However, in recent years mobile smart devices have rapidly been developed and are starting to enter the healthcare sector. Since healthcare personnel often are highly mobile in their occupation; moving between different patients, rooms and care units, mobile devices are welcomed. (Su & Liu, 2010) An important aspect when developing solutions for the healthcare industry are the high hygiene demands on products used within hospitals and other sensitive environments which automatically applies to this master thesis project, working towards hospitals. In order to limit risks of health-care associated infections, there are regulations set by the Swedish National Board of Health and Welfare (Alexandersson, 2007). These include eleven points concerning working- clothes, accessories, disinfection and protective equipment.
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1.1.1 Tieto
Due to the many problems with healthcare information technology, the IT consultancy company Tieto aims to target the healthcare industry from several angles. Tieto is the largest Scandinavian company offering IT services, having 14 000 employees in twenty countries and a turn-over of 1.6 billion euro. The aim of Tieto’s work is to develop companies and societies using IT and create opportunities for their customers to transform their businesses. Tieto works towards several different industries, among them are healthcare and welfare, telecom, energy utilities and financial services. The company is divided into four groups working with different industries;
Financial Services; Manufacturing, Retail and Logistics; Public, Healthcare and Welfare; and Telecom, Media and energy. (Tieto, 2014)
1.2 Purpose
The purpose of this master thesis is to, by the use of a suitable development process; define work routine problems and potential improvements for nurses working at care units, and to develop a conceptual smart wearable device solving such a problem.
1.3 Delimitations
The study choses to focus on registered nurses working at care units with hospitalised patients since this are one of the most common sorts of nurses (Socialstyrelsen 1, 2013; Socialstyrelsen 2, 2013). Due to time and traveling limitations four different hospitals were visited where three of them were located in Stockholm and one in Gävle. The project stretched over a limited period of time, 20 weeks, which is why only a concept is developed and not a functioning product.
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2. F RAME OF REFERENCE
The frame of reference functions as a platform for the master thesis project and is continuously involved in decisions regarding the project. In this chapter the frame of reference is presented, divided into three main areas important for the project; product development, information technology and information technology within healthcare.
2.1 Product development
Product development is by Ulrich and Eppinger (2012) defined as the interconnected activities starting with a market demand or opportunity and ending with production, sale and delivery of a product. Kahn (2013, p. 462) describes the same concept as “The overall process of strategy, organization, concept generation, product and marketing plan creation and evaluation, and commercialization of a new product.” There are, as debated by Ulrich and Eppinger (2012), several definitions of the product development process and, therefore, no universal process that works in all situations. Three different product development processes are presented below due to their appropriateness for the master thesis, as well as different methods of involving the user in product development and ergonomic aspects of product development.
2.1.1 Product development process
A product development process is a sequence of phases that are needed for the development of a product (Ulrich & Eppinger, 2012). Magsalay (2012) states that a solid framework must be used when bringing new products to the market in order to ensure quality of the products. A well- defined product development process enhances the quality, coordination, planning and management when used right (Ulrich & Eppinger, 2012). The generic product development process explained by Ulrich and Eppinger (2012) consists of six phases; planning, concept development, system-level design, detail design, testing and refinement and production ramp-up, Figure 1.
Figure 1. The generic product development process (Ulrich & Eppinger, 2012).
A spiral product development process is also explained by Ulrich and Eppinger (2012), which is suggested for quick-build products. In the spiral development process designing, building and testing are iterated until desired result is accomplished. Ullman (2010) describes another spiral process which begins with an initial concept that is prototyped, evaluated and refined. The
Planning Concept
Development
System-Level Design
Detail Design
Testing and Refinement
Production Ramp-Up
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second spiral is then started where a second concept is prototyped then evaluated and refined.
The process then continues until the final product is developed.
2.1.2 User involvement in product development
There are many different definitions of what a user is, ranging from Warell (2001) claiming a user is an individual who interacts with the product at any stage of the product’s lifecycle to Karlsson (1996) claiming the user to be defined only as the end user. With Warell’s definition individuals such as repair staff, waste handling staff and producers are included as users, along with end users. For this master thesis project, the users are defined as Karlsson’s description, being end users.
In a traditional product development project users are not involved until the product reaches market. They will then function as an indicator of the success of the product. (Durugbo & Pawar, 2014) Potentially due to this, nearly nine out of ten products fail within two years on the market (Ericson, et al., 2007). However, involving the user and performing participatory design, has been discussed and debated for several decades (Reich, et al., 1996). When performing traditional product development, customer needs are captured from the perspective of scientists and engineers. In the final stage of a development process, customers are consulted and expected to give feedback on functions and experiences of the product. (Durugbo & Pawar, 2014)
According to von Hippel (2005) more involvement of users in the development process, offers great advantages over the traditional development. In contrast to traditional development, users can create products exactly as they want them, instead of relying on companies acting as their agents. The users give value to companies by sharing their critical input, and sometimes even being the sources of innovation (Bogers, et al., 2010). There are different ways of involving customers and users when developing a product, some methods relevant for the master thesis are explained below.
User-Centred Design
Norman (2000) defines user-centred design as a philosophy based on the needs and interests of the user. This, he claims, emphasises the importance of making products usable and understandable. Summarised, Norman states design should make the determination of possible actions easy and make use of visibility when it comes to alternative actions and results. He also claims design should make the evaluation of current system state easy and follow natural connections between intentions and required actions.
Concept testing
Concept testing is a method physically involving the users already in the development phase.
Users are often showed stimulus material such as quick sketches, models and prototypes and the concepts are explained in detail. (Kaulio, 1998) The use of prototypes, models or sketches can generate a deeper understanding of the concept and are, therefore, preferable (Schneider &
Stickdorn, 2013). It is important that the concepts are realistically and understandably explained for enabling the users to give proper feedback. Generally, concept testing is well-suited for using in a development project divided into different phases or stages and also good to combine with later beta testing. (Kaulio, 1998)
5 Scenarios
When developing a product, service or system, there is an importance of understanding situations and settings where the matter is used (Carroll, 2000). This can be done by documenting persons and actions in text, storyboards or videos which is commonly called scenarios (Schneider &
Stickdorn, 2013). Scenarios are hypothetical stories giving insight on problems and interpretations of current states (Carroll, 2000). Bødker (2000) emphasizes that scenarios always are made with a purpose relating to both the situation and design solution. There are three proposed main reasons for using scenarios suggested by Bødker (2000); to present and situate the solutions, to illustrate alternative solutions or to identify potential problems.
2.1.3 Ergonomic aspects of product development
The definition of ergonomics for this master thesis project is formulated by the International Ergonomics Association (2014) and explains as follows.
“Ergonomics (or human factors) is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance.”
Ergonomics is beneficial to include in the product development process both for new products and refinements of old products due to several different reasons. These reasons can be divided into three levels; individual level, organisational level and community level. On an individual level ergonomics can infer decreased stress levels, increased safety, satisfied users and increased well- being. On an organisational level ergonomics can increase productivity, competitiveness, quality and productivity. On a community level ergonomics can infer increased competitiveness, safety and improved economics. (Boghard, et al., 2008)
Due to the purpose of the master thesis, ergonomics concerning human-technique systems are of main interest. Such systems include a human operator and technical product that interact in order to perform a task. Cognitive processes, how humans register information from the surroundings, are therefore important to consider. (Osvalder & Ulfengren, 2008) Several ergonomic aspects and design principles regarding human-technique systems and cognitive processes presented by Boghard et al. (2008) are applicable to this master thesis project and presented below along with supporting references.
Visual ergonomics
The science of visual ergonomics is multidisciplinary and includes understanding the human visual processes and visual registration of the surroundings along with interaction between humans and other parts of the system. Theories and models are used to optimise performance and efficiency of such systems. Some visual ergonomics theories relevant for the master thesis are presented below. (International Ergonomics Association, 2014)
When presenting information on a display, information should be short and concise in order to be apparent. Displays also need good readability which implies high contrast, good lighting and the right angle of vision. (Osvalder & Ulfengren, 2008) According to Arbetsmiljöverket (2012), the ideal contrast for reading on displays is to have dark characters on a seven times as light background. Black background on the display is also dissuaded for most situations due to the
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large contrasts to the surroundings that often are of a lighter character. Another important aspect for the readability is choice of font. When reading on paper, fonts with serifs increase readability while fonts without serifs are easier to read on displays. Hägg et al. (2008) claims that when researching angle of vision, it has been proven 15º below the horizontal line to be most comfortable. Most individuals prefer an angle of vision of between the horizontal line and 30º below. An angle of vision higher than 45º is not recommended.
Osvalder and Ulfengren (2008) emphasises the importance of colours used when presenting information. Use of colours is a delicate matter and should be treated with caution. Colours can create uncertainty and fatigue and can be perceived as playful and superficial. There are however great benefits of using colour coding such as quicker understanding of information, faster reaction time, attention to specific data and separation of close objects. Certain colours are commonly associated, but the associations can to a certain extent differ because of cultural conditions. In the western world the following colour combinations are commonly used:
Stop, danger, warm, fire Warning, slow, testing OK, go, continue, on Cold, water, calm
Figure 2. Colour combinations commonly used in the western world, adapted from (Osvalder & Ulfengren, 2008).
Apart from colours used in the right way, symbols are efficient communicators of information. In order to improve understanding the symbols need to be well-known and unambiguous. When used right, symbols have several advantages over text; the symbol can be seen from longer distance, information will be perceived faster and with a smaller margin of error, if the symbol is partly destroyed or hidden it can still be found and understood, symbols are often interpreted the same on an international level. (Osvalder & Ulfengren, 2008)
To support design of a visual display, some design principles have been set up by Osvalder and Ulfengren (2008). One of the principles applicable to the master thesis project is the principle of consistent presentation. The principle of consistent presentation emphasises the importance of, when designing new interfaces, using as much previous knowledge the operator has as possible.
This means the same symbols, colour coding and placement as in interface previously used by the operator.
Often when designing a visual interface, there are levers and buttons connected to the display.
When designing buttons, there are certain guidelines to follow. If the buttons are supposed to be marked with symbols or text, square buttons are to prefer over round. Dimension of the buttons should also be considered in the design phase. The diameter of a button should not be less than 0,64 centimetres and if the button has a diameter between 1,9 and 2,5 centimetres, a concave surface can facilitate localisation of the button. (Woodson, et al., 1992)
Audial ergonomics
When developing technical systems the use of audio for warning is natural due to the inability for humans to, without assisting devices, turn off hearing. One great advantage of using audio for attentive purposes is that; sounds are registered even when not listened for explicitly. However, sounds can also create distraction and communication disablers and on which side of the line a
7 sound is placed depends on the situation and surroundings. There are three substantial perceptive variables of sound; intensity, frequency and direction. Warning signals exist in order to alert the operator and enable judging the nature of the problem, severity and sufficient intervention.
Therefore, warning signals need to be easily separated from other noise, easy to understand and remember. The signals need to be well heard but not annoyingly loud or consistent to not be perceived as distracting or disturbing. (Osvalder & Ulfengren, 2008)
Alarm systems
When creating an alarm system both visual and audial components are often used in the combination of an audial alarm being followed by information on a display or screen. Alarm systems are used to alert the operator of deviations and to correct error conditions. It is important to not use the alarm system for planned events, only unexpected incidents. By differing the substantial perspectives of sound; intensity, frequency and direction, different sounds can be created and quickly inform the operator on which incident that has occurred. A maximum of three priority levels is however recommended for alarm systems. This because humans have difficulties separating more sounds than three. The lowest level of priority should alarm at least 10 dB over the normal volume that the product produces. Concluded, Thunberg and Osvalder (2008) describe a good alarm as being:
Relevant – not a false alarm or alarm of low use.
Unique – the alarm should not be a duplicate of another alarm.
Convenient – the alarm should be on the right time.
Prioritised – the importance of the alarm should be displayed so the operator can prioritise the effort.
Understandable – simple and easily understandable message.
Diagnosing – identify the problem that has occurred.
Advising – indicate the action to be taken.
Focusing – draw attention to the most important aspects.
Alarm Fatigue
In the current healthcare environment, many different devices are used to assist and serve the patients. All of them using different sounds and lights to attract attention and communicate their information. When the frequency and number of alarms become overwhelming alarm fatigue may occur which can lead to longer responding times. Alarm fatigue also occurs in other environments than healthcare, for example in industries such as nuclear power and aviation, and the consequences are similar. (Solet & Barach, 2012)
A study performed at The John Hopkins Hospital in Baltimore presented there were 350 alarms per patient every day. The purpose of the alarms is to announce when the status of the patient differs from the predetermined normal status (Sendelbach & Funk, 2013). In the healthcare sector, 80 up to 99 percent of the alarms are false which in this context means the patient is not endangered. False alarms often occur because of absent or incorrect patient data which can be caused by patient movement or incorrect positioning of sensors. Recurrent false alarms can result in slower responding time in an emergency (Tanner, 2013). A study made in the U.S. between January 2010 and June 2010 identified 216 deaths linked to alarms on patient monitors, many
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where results from a delayed response or even the absence of response. In order to eliminate alarm fatigue the number of false alarms needs to decrease. (Solet & Barach, 2012)
2.2 Information technology
Information technology is a concept that regards uses of systems that facilitate storage, processing, transfer and presentation of information. Examples of such systems are computers, smart phones and tablets. Information technology constitutes a large part of the modern society and most institutions rely on the technology. (Gupta, 2010)
2.2.1 Internet of Things
Connection to anyone, anywhere and at any time is currently enabled by the use of internet.
However, development is about to progress further by adding the new dimension “anything”.
The addition of “anything” will enable new ways of communication between people and things as well as between things themselves (International Telecommunication Union, 2005). According to Pang (2013) addition of the new dimension will have the same dimension of impact on human life as the internet had in the past decades. The concept Internet of Things (IoT) refers to the idea of seamlessly connecting people and things of interest (Pang, 2013). IoT will affect everyday life in many ways, exemplified in the potential utilisation areas of e-health, assisted living and enhanced learning (Atzori, et al., 2010). To enable such innovation electronics have to be embedded into existing physical objects making them “smart” and allow them to connect with the global network (Miorandi, et al., 2012). Some wireless communication technologies that can contribute to enabling an IoT society are presented below.
Radio Frequency Identification
The first step in connecting things to databases is to find a simple cost effective item identification system (International Telecommunication Union, 2005). Radio frequency identification (RFID) uses wireless communication technology to identified tagged objects. There are three basic components in an RFID system; a tag, a reader and a controller. The tag consists of an antenna and an electronic chip where data can be stored. The tag can communicate with the reader by the use of radio waves. When a tagged object reaches the read zone of the reader it signals the tag to transmit the data stored on the chip. (Hunt, et al., 2007)
The read range on the RFID tag can differ extensively depending on whether the tag is active or passive. An active tag is used when the tag needs to transmit data to the reader. For this to be possible, the tag needs to include a battery which enlarges the tag, makes it more complex and expensive than a passive tag. However, because of this active tags can interact with less powerful readers on a distance up to 30 meters. A passive tag has no battery of its own, instead it derives power from the reader and, therefore, the read range could be as short as 60 centimetres. This also results in a smaller and much cheaper tag. (Hunt, et al., 2007)
Near Field Communication
Near field communication (NFC) is based on the technology used in RFID systems, but it is limited to connect when the devices are up to 10 cm apart (Curran, et al., 2012). The technology can wirelessly connect two devices containing NFC tags by the use of short range radio waves (Sharma, et al., 2013; Curran, et al., 2012). NFC can provide bidirectional communication, meaning it can send and receive information simultaneously. Certain phones are currently
9 equipped with NFC tags, enabling them to communicate with devices containing NFC tags. The phone can be used for payment by placing it in front of a phone reader. The purchase will then automatically be paid from the customer’s bank account. (Sharma, et al., 2013) As more manufacturers are equipping their phones with NFC tags the needs and possibilities for new applications are increasing rapidly. NFC is a very natural and user-friendly way of connecting things and only needs the objects physically connected in order to establish communication.
(Curran, et al., 2012) Bluetooth
Bluetooth is one of the most utilised wireless communication techniques in the world (Stirparo &
Löschner, 2013). The technique enables wireless communication between small electrical devices without a line of sight connection. Bluetooth is often found in cell phones and enables the phone to connect with external devices such as headsets and computers. To establish a connection the phone simply needs to be in range of the embedded radio transmitters. Bluetooth is often used to connect computers with Bluetooth enabled keyboards, printers, scanners and mice to minimise the use of messy cables on the desktop. (Sauter, 2011) Bluetooth is also used within the healthcare sector; early in 2011, 40 million Bluetooth enabled health and medical devices were on the market. (Stirparo & Löschner, 2013)
Several devices can exchange information simultaneously with the use of Bluetooth, but that affects the transmission speed. Different power classes have been defined; class 3 devices are designed to work on a distance of 10 meters through a single wall and class 1 devices works up to 100 m and can penetrate several walls. Battery driven devices are commonly designed to fit class 3 and devices not concerned of the energy consumption designed for class 1. (Sauter, 2011)
Infrared Communication
Infrared (IR) communication refers to the use of infrared light waves for communication and transmission of information. IR can be used for either communication between portable devices or between a portable device and stationary base point (Carruthers, 2002). Infrared light and visible light are close together in wavelength, resulting in similar properties. They both get absorbed by dark objects and reflected by shiny surfaces. IR signals require a clear line of sight between the transmitter and the detector and, as visual light; it can pass through glass but not walls. IR technology is a cost effective alternative to achieve transmission of high speed. (Kahn &
Barry, 1997)
Global Positioning System
The Global Positioning System (GPS) can be used for many different applications but, as indicated in the name, it is a technology used to locate objects, persons and to navigate. There are three components in a GPS system; the space, the control and the user. The space segment refers to the satellites orbiting the earth. Each satellite sends out radio signals that receivers use to calculate the position. The control segment refers to the organisation that has the responsibility to monitor and maintain the satellites since their exact location in space is essential for correct calculations. The last segment is the user who can utilise the information in different ways, for example, to calculate speed or to find a position. (Spencer, et al., 2003) GPS can calculate reliable information of a position independent on weather conditions, but it requires a clear line of sight of a minimum four satellites to obtain highly reliable information (Ordóñez, et al., 2012).
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Wifi
Wireless local area networks (WLAN) provide wireless internet connection and Wifi is the most widely spread WLAN technology. Radio waves are transmitted by a base station which can provide connection over a limited area, but it is possible to connect the stations and create a continuous coverage over a wider area (Lehr & McKnight, 2003). Currently 25% of all homes worldwide have Wifi and two billion Wifi enabled devices were estimated to be sold in 2013 (WiFi Alliance, 2013).
2.3 Information technology within healthcare
Information technology plays a big part even within the healthcare sector; most medical institutions today are using information technology to improve their quality and efficiency (Su &
Liu, 2010). Information technology in healthcare is often referred to as health information technology, or HIT (Scandurra, 2013).
2.3.1 Health information technology in Sweden
As the name suggests, health information technology (HIT) concerns information technology used within the healthcare sector. When used right, HIT can increase efficiency, improve life quality for both patients and medical staff, and strengthen innovative patterns in healthcare.
(Scandurra, 2013) In 2010, the Swedish government adopted a strategy called Nationell eHälsa (2010), a strategy working towards safe and accessible information. The strategy works towards three target groups; the individual including patients, inhabitants and relatives; healthcare personnel; and decision makers within the healthcare sector. Different kinds of support for the different target groups are integrated in the strategy. Individuals are supposed to have easy access to quality secured information regarding healthcare, welfare and personal treatment. Healthcare personnel should be provided with well-functioning and integrated IT-support, facilitating daily work. Decision makers should have tools for reassuring quality and safety, and be provided with a comprehensive foundation to base decisions on. (Socialdepartementet, 2010)
To follow up Nationell eHälsa, Socialdepartementet engaged a review of the strategy in order to find significant areas for development. The review resulted in the study eHälsosystemens användbarhet (Scandurra, 2013) being engaged within the dominating problem area; usability for healthcare personnel in existing systems. eHälsosystemens användbarhet 2013 resulted in a review of current obstacles, important solutions and changes needed to improve the information technology support. Among the suggested priorities for continued work was to involve user experience experts and healthcare personnel to a larger extent, focus on mobility in information accessibility, education of health care personnel, reduce double documentation and continuously optimise HIT systems relative to usability. (Scandurra, 2013)
2.3.2 Mobile devices used in healthcare
Computers are currently used on a daily basis in the healthcare sector and are accepted by the medical staff. But as mobile devices are developing in a rapid pace they have also entered the medical field. Since nurses and physicians are very mobile and move frequently between different rooms and locations the use of mobile devices is urgent and welcomed. (Su & Liu, 2010)
Breslin et al. (2004) have studied a wireless product made for hospitals called The Vocera Communications System. The product operates similarly to a portable phone, but there is no
11 need for phone numbers; instead the user can choose a name, function, title or group to call. It also has voice control and the ability to make conference calls. The technologies used are WLAN, IP telephony and a speech recognition software program. The study mentioned above analysed two care units, one who used Vocera and one who used traditional communication tools. The findings of the study were; that the Vocera has a positive impact on the workflow, and was more than five times faster to use than traditional communication methods.
Su and Liu (2010) have investigated utilisation of a personal digital assistant (PDA), a small mobile handheld computer, in healthcare environments. The aim of the product according to Su and Liu (2010, p. 1140) is to “provide the right information to the right health care provider about the right patient at the right time and right place” which is done by wireless communication and networks. Su and Liu argue that PDAs have high potential and predict that they will have a more important role in the future of healthcare. Negative aspects of the PDA were identified to be the user interface; the size of the screen is limited to keep the PDA highly portable. The small screen makes it difficult for the user to interact but when the screen was shown in colour the users performed better.
In a research made by Di Pietro et al. (2012) the use of mobile information technology to improve nurses’ access to and use of research evidence is studied from a usability point of view.
The software program tested in the study was a clinical decision-support system which aims to improve the quality of care, reduce medical errors and improve clinical practice. The mobile devices used to run the program were a PDA or tablet PC. The findings of the study show that navigation through the program was one of the biggest problems. Di Pietro stresses the importance of providing information to the nurses at point of care, as well as the importance of IT education and future research of usability within the nurses’ clinical context.
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3. M ETHODOLOGY
In this chapter theory on the different methods used for the master thesis is presented. To a certain extent, the method theory is presented in chronological order starting with planning, followed by empirical research, concept development and testing and validation.
3.1 Planning
Being the initial phase of a project, the planning phase plays an important part. Planning for a project enables a formalisation of the project process to ensure efficient use of resources. For the plan to function as intended, the project is broken down into tasks that are divided into phases.
(Ullman, 2010)
3.1.1 Time plan
When the tasks have been listed, the time plan is created. Ullman (2010) suggests using a bar chart or Gantt chart, claiming it to be the most efficient method. On such a chart, tasks are plotted against a timeline.
3.1.2 Specification of requirements
When initiating a project, discovering and defining requirements is of significant importance. A project without defined requirements cannot anticipate what needs to be done and the extent of the work. There are two fundamentally different types of requirements; business requirements and product requirements. Business requirements are formulated from the perspective of the business and provide value when met. Product requirements assume one specific solution to meet the business requirement, in the form of a product. These requirements include design of the product and provide value only if they meet the business requirements. The product requirements can be divided into functional and non-functional requirements. The first category includes functions that the product shall or should have. Non-functional requirements include every type of requirement except for functional requirements, for example constraints.
(Alexander & Beus-Dukic, 2009)
3.1.3 Stakeholder analysis
A stakeholder is anyone with an interest in the project, process or outcome. Usually there are many stakeholders in one project with different objectives and requirements. The first step when conducting a stakeholder analysis is to identify the stakeholders. Stakeholders can be divided into three categories; internal, external and the “rest of the world”. Internal stakeholders are typically the members of the project team and the governance structure. External stakeholders are usually those whom the project is being provided for, such as the customers and investors in the project.
These people are crucial for the success of the project, but are not a part of the project organisation. The “rest of the world” is a term used to refer to the rest of the stakeholders not that closely involved in the project but still gets affected. Generally it is not hard to identify many stakeholders; the challenge is to know when to stop the process. (Maylor, 2010) Each stakeholder has different requirements and expectations and it is usually not possible to make everyone happy (Alexander & Beus-Dukic, 2009).
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Stakeholders are often prioritised by their relative power (Alexander & Beus-Dukic, 2009). In this context power can mean direct authority, indirect authority or an important relationship with the project team. The level of interest and impact are other aspects that are important to take into consideration when managing stakeholders. Interest and impact refer to how much the stakeholder knows about the project and how much they are affected by it. In order to create a stakeholder map the different stakeholder’s power and interest are rated and gives a rough idea on how to manage them. (Maylor, 2010)
Competitor identification and analysis
Competitor identification is important and used within many different fields. It can be used to set prices, review the product design and development, investigate competitive advantages, review communication strategies and how to distribute the product. The identification is important to do to increase awareness of competitors’ opportunities and threats. In the initial stage, the market should be searched broadly to minimise the risk of being blindsided. When the competitors are identified they should be compared in a competitor analysis on the basis of relevant dimensions.
(Bergen & Peteraf, 2002)
3.2 Empirical research
Theory of different empirical research methods is explained in the following section, starting with explaining qualitative and quantitative methods, the method of shadowing, interviews and finally explaining the Customer journey map.
3.2.1 Qualitative and quantitative methods
The results that different methods generate can be classified as qualitative or quantitative data (Osvalder, et al., 2008). Quantitative data is usually presented in actual numbers that have been generated by objective methods where the data is gathered by direct measurements. It aims to generate generalised results or to test a hypothesis (Osvalder, et al., 2008; Murray, 2003).
Qualitative data aims to generate an understanding for a specific case instead of a generalised result. Qualitative methods can handle a lot of different variables and are often used when only a few cases are investigated (Osvalder, et al., 2008).
3.2.2 Shadowing
Shadowing involves a researcher following a subject over an extended period of time (Mcdonald, 2005). The method is utilised to find out first-hand what the events of the subject’s life are. It is particularly suited for situations when an individual is not in focus for analysis, rather the interactions with the environment. (Quinlan, 2008) Through shadowing situations where people say one thing but act differently can be identified (Schneider & Stickdorn, 2013). When shadowing, the researcher asks questions for clarification or revealing of purpose. Notes are continuously taken by the researcher for remembrance. Using shadowing as a data collection method gives more detailed data compared to many other approaches. However, there are also problems with using shadowing as a research method. The observer effect, where the subject acts differently due to being observed is continuously present throughout the shadowing. Moreover, the large amount of data collected can present a challenge when compiling information.
(Mcdonald, 2005) During shadowing, the subjects can be asked to think aloud, a method which is often used to understand the cognitive process not visible to observers (Fonteyn, et al., 1993).
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3.2.3 Interviews
Interviewing is the most fundamental method to gain qualitative information and find emotional aspects. There are three types of interviews; unstructured, semi-structured and structured interviews. A structured interview primarily generates quantitative data while the result from an unstructured interview is only qualitative data and can be difficult to analyse and compare. In a semi-structured interview, the questions asked is a mix of predetermined and open ended questions to gain deep understanding of the topic, but also to give a foundation to make a systematic analysis of the data. (Osvalder, et al., 2008)
3.2.1 Customer journey map
A Customer journey map is a tool used to visualise the user experience of a service or product and involves all the events and activities related from a customer perspective (Schneider &
Stickdorn, 2013; Zomerdijk & Voss, 2010). The first step when constructing a Customer journey map is to identify the touchpoints, where the user interacts with the service or product. This could be done by the use of different methods for example interviews or letting the users construct their own map. Examples of touchpoints could be virtual interaction on a website, face to face contact or a trip to a specific place. The next step is to connect the touchpoints into a structured visualisation of the journey. It should incorporate as much information to provide real insights to the journey but still be easy to understand for everyone. (Schneider & Stickdorn, 2013) The map is used to understand what the users feel and how they are behaving across the journey (Zomerdijk & Voss, 2010). A way to make it more personalised is to incorporate personas and user quotes. The map provides an overview of the service and enables identification of problem areas and areas for improvement. (Schneider & Stickdorn, 2013)
3.3 Concept development
There are a great number of concept development methods available both for individuals and groups. Theory of the methods used for this master thesis project is presented in the following section.
3.3.1 Brainwriting
Brainwriting is an ideation method where writing and sketching in silence is used. The ideal number of participants for Brainwriting is claimed to be six persons. When the group is ready everyone is provided with a paper divided into three columns. The paper will have as many rows as ideation rounds that will be performed. During the first round of ideation, everyone communicates three different ideas in the three columns. The ideas can be written, sketched or both, as long as they are understandable. (Silverstein, et al., 2009) This round lasts for five minutes and no talking is allowed during that time. When the first round is done, the second round is started by the papers being sent to the person on the right. The ideas already written on the paper are read through and then built upon in the next row of the paper. The rounds will continue until everyone has written on each paper. (Ullman, 2010)
3.3.2 Systematic inventive thinking
Systematic inventive thinking is an ideation method taking the elements of the product into consideration rather than the user. Goldenberg et al. (2003) promotes this method to create ingenious and viable ideas. Starting with an existing product, the method lists physical
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components and attributes of the product. Then one or more out of five different patterns are applied to the listed elements. The first pattern is subtraction where elements of the product, especially desirable ones, are removed and new products and ideas are then generated from that.
The next pattern is multiplication where elements are multiplied and the multiplication given a slightly different function. Division is the following pattern and here the product is divided into its component parts which make it possible to see the product in a new light. The next pattern is task unification where new tasks are assigned to existing elements of the product. The last pattern is attribute dependency change and concerns the dependent relationships that already exist between attributes of a product and attributes of its environment. As many or few of the pattern as preferable are chosen to apply on the existing product. Systematic inventive thinking can then generate new and innovative ideas and products when used right. (Goldenberg, et al., 2003)
3.4 Testing and validation
There are different ways to test and validate concepts and ideas in a product development project. Two of them are explained below; storyboards and prototypes.
3.4.1 Storyboards
Storyboards can be used to present different stories and scenarios concerning a product or service and utilisation of the same. A storyboard consists of sketches and drawings put in a sequence to explain a specific event or occurrence. The story presented can involve an existing product or a concept of a new product depending on the purpose. Storyboards are made to give insight on the user experience and can provoke meaningful analysis and discussions around the product. For the designer creating the storyboard only the process of creating it gives insight on the user perspective because of the need of understanding the user in order to create a sufficient storyboard. (Schneider & Stickdorn, 2013)
3.4.2 Prototypes
Prototypes are used to transform ideas into physical things. A prototype can be anything with a physical form, for example; a wall of Post-It notes, a cardboard model or an interface (Hasso Plattner Institute of Design, 2010). In service design, prototypes are a simulation of a service which can involve everything from roleplay to detailed full-scale recreations with props and physical touchpoints (Schneider & Stickdorn, 2013). Ulrich and Eppinger (2012) states that a prototype is an approximation of the product, referring to one or more interesting dimensions.
Anything that shows any aspect of the product of interest can be viewed as a prototype, including sketches, simulations and mathematical models.
Prototypes can be classified in two different dimensions. The first dimension goes from analytical to physical. In an analytical prototype aspects of the product are analysed instead of built. This is made usually by the use of nontangible artefacts such mathematical models, pictures and simulations. Physical prototypes are tangible artefacts where interesting aspects of the product are actually built for testing and experimentation. This includes prototypes that look and feels like the final product as well as rough models used for testing a quick idea. The second dimension goes from focused to comprehensive. A focused prototype is a prototype focused on a specific part or attribute of the product, an example is a foam model exploring the shape and size of the product.
In a comprehensive prototype most, or all, of the attributes of the product are included. A
17 comprehensive prototype can be given to users for final testing and to identify design flaws before starting producing the product in full scale. (Ulrich & Eppinger, 2012)
The level of the prototypes should correspond to the state of the project. At the beginning of the project rough and rapid models should be made to investigate a lot of different solutions and options and in the final stage comprehensive models should be made for testing and evaluation (Hasso Plattner Institute of Design, 2010; Ulrich & Eppinger, 2012). Prototypes can be used for many different purposes. They can be used as learning tools to discover if an idea will work or how well it meets customer needs. Prototypes facilitate communication between different actors and stakeholders in a product development project. It is much easier to understand how a product is supposed to work and look like when there is a model or picture available instead of just words. (Ulrich & Eppinger, 2012) A fundamental way of using prototypes is to test them on the intended user to receive feedback on the product and to gain deeper understanding of the user. This can be done iteratively beginning with simple artefacts as prototypes (Hasso Plattner Institute of Design, 2010).
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4. I MPLEMENTATION
A large part of the thesis work has been focused on implementation, which is explained in this chapter. The chapter is organised in chronological order where all phases of the project are explained. How different methods were used in the project, along with their respective result, is presented. The only result not presented in this chapter is the very final one, which can be found in chapter 5 Results. Connections to the frame of reference have been made continuously during the implementation and can in this chapter be found.
4.1 Literature study
When initial planning was done, a literature study was initiated. The literature study was performed to find relevant information regarding subjects processed in the project, as well as to support analyses of data obtained in later stages of the project. Scientific databases such as ScienceDirect and Scopus were used in order to find journal articles regarding technical and scientific aspects. Due to the healthcare orientation of the project, medical databases such as SveMed+ and PubMed were also used for extracting information. As a complement to the journal articles, relevant written sources attained from the KTH library were also included in the literature study. The literature study was iterated and more specified along the project because of new information being needed for theoretical support.
Key words: Internet of things, Health information technology, Smart watch, Smart wearable tool, Alarm fatigue, User involvement, Qualitative methods, Product development process, Usability, Nurse, Mobility, Healthcare, Wireless, Cognitive ergonomics.
4.2 Planning
In the initial stage of the project, a plan for the timeframe as well as processes and methods that were going to be used was done. Information in planning documents was continuously updated throughout the project and more detailed plans continuously made. The planning phase was important to go through as the first step of the project due to the importance of getting an overview and understanding of the project. It was also important to, as Ullman (2010) states;
ensure efficient use of resources.
4.2.1 Process plan
The development process chosen for this master thesis project is a spiral development process, adapted from the Ulrich and Eppinger spiral product development process (Ulrich & Eppinger, 2012). The development in this project was meant to be performed in close contact with users because of the advantages explained by von Hippel (2005), Bogars (2010) and Scandurra (2013).
The users were to be involved in testing and validation and the received feedback then be used as a foundation for further development. The plan for this project was to perform three iterations of development and testing. A literature study was added to the process and was performed in parallel with other project phases. The reason for the literature study being parallel to other phases was the need for continuously finding research and theory relevant for the project. The full development process is shown in Figure 3.
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Figure 3. Spiral development process used for the master thesis project.
4.2.2 Time plan
After deciding which phases to include in the project a time plan for the length of the different phases was set. The time plan included the different phases and also took into consideration the possible need of overlap of the phases. It was divided into weeks and constructed in Excel, as a Gantt chart. For the time plan, see 0. A detailed time plan divided into days was also done in the planning stage of the project. The detailed time plan was then updated as the project proceeded and more insights obtained.
4.2.3 Risk analysis
In order to identify and minimise risks in the project, risk analysis was performed. Risks were listed and graded on likelihood of occurrence as well as consequence if occurring. The value for likelihood and consequence was decided to vary between one, three and nine. One means low likelihood or consequence and nine means high likelihood or consequence. The risk value was then calculated by multiplication of likelihood and consequence. The last step of the risk analysis was to create an action plan in order to prevent the different risks. The two highest rated risks are shown in Table 1. For the entire risk analysis, see Appendix 2.
Table 1. The two highest rated risks in the risk analysis.
Risk Probability Consequence Risk value Action
Dissatisfaction from KTH 3 9 27 Keep continuous contact and
update KTH on development of the project.
Communication problems 9 3 27 Make sure to continuously
communicate with all relevant stakeholders.
4.2.4 Specification of requirements
In order to narrow the project scope down and to gain understanding of specific goals to work towards a specification of requirements was set by the authors. The requirements were divided into project goal which is a business requirement according to Alexander and Beus-Dukic (2009);
functional criteria, limiting criteria and other criteria that are classed as product requirements (Alexander & Beus-Dukic, 2009). The most important requirements are presented in the bullet list below, for the full specification of requirements, see Appendix 3.
The product shall have the ability to measure time.
The product shall be able to communicate with other smart devices.
The product shall be easy to understand.
The product shall be attachable to the nurse´s uniform.
The product shall be waterproof.
Planning Empirical res
Literature study
Concept dev Test & validation
Finalising
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4.2.5 Stakeholder analysis
The stakeholders were identified in a brainstorming session focusing on the three categories of stakeholders identified by Maylor (2010). Internal stakeholders were identified to be Tieto, the Royal Institute of Technology and the authors. External stakeholders were identified to be nurses, hospitals and Stockholms läns landsting. In Table 2 these stakeholders are listed together with the most important “rest of the world” stakeholders; manufacturers, patients and competitors. After listing the stakeholders, they were evaluated on a scale between zero and five according to how much power and interest they had in the project. Zero indicates low power or interest and five indicates high.
Table 2. List of stakeholders rated depending on their power and interest.
Category Stakeholder Power Interest
Internal Tieto 5 5
Royal Institute of Technology 3 2
External Nurses 5 5
Stockholms läns landsting 3 4
Hospitals 3 4
Rest of the world Patients 1 3
Manufactures 3 1
Competitors 2 3
The most important stakeholders in this project are the nurses, for whom the project aims to help facilitate their daily work, and Tieto that is paying all expenses and expects a relevant result in return. Stockholms läns landsting and hospitals both have much power and interest in the project since they decide what care units can invest in and are highly interested in increasing quality and saving money. Patients have low power since this product is not supposed to be used by them but they have bigger interest since the project aims to help nurses, which can lead to a better hospital environment with medical staff that have more time for nursing. Manufactures have a relative high power since manufacturing methods and cost can limit the product but their interest is very low. Last are the competitors that have relatively big interest and some power since products existing on the market will affect the result.
Competitor identification and analysis
As mention above existing products and competitors will have an effect on what kind of solution this project will result in. Therefore, a competitor identification and analysis was made to investigate which smart wearable devices exist on the market. According to Bergen and Peteraf (2002), the competitor analysis should be done early in the project and the search broad.
Therefore the initial analysis was done in this stage of the project and several different smart devices were analysed and compared.
Four different smart watches were investigated and some of them tested; Pebble, Sony SmartWatch, Samsung Galaxy Gear and Motorola Moto 360. Sony SmartWatch and Samsung Galaxy Gear were chosen because they were available to test in a local store. Pebble was picked because the industrial supervisor of the project talked about it and Motorola Moto 360, which will be launched in the summer of 2014, was read about because it will be the first smart watch with a round display. All watches are designed to be worn around the wrist, have similar features
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and connect to a smartphone via Bluetooth. They all, except for Pebble, have a colour touch screen. To customize the watches applications can be downloaded and installed and all, except for Samsung Galaxy Gear, enables exchange of the wristband. Picture of the four watches can be seen in Figure 4. (Pebble, 2014; Sony, 2014; Samsung, 2014; Motorola, 2014)
Figure 4. The four smart watches investigated, listed from the left; Pebble, Samsung Galaxy Gear, Sony SmartWatch, Motorola Moto 360. (Pebble, 2014; Sony, 2014; Samsung, 2014; Motorola, 2014) Different smart wearable exercise devices were also interesting to investigate since several new products recently reached the market. Nike+ Fuelband, Fitbit Flex and Jawbone UP24 are three different products with similar features, see Figure 5. All products are worn around the wrist and contain accelerometers used to track the movement of the user. The information is then sent to a smartphone via Bluetooth where an application compiles the information into comprehensible graphs. They exercise devices are designed like an upgraded pedometer and meant to be worn constantly. Fitbit Flex and Jawbone UP24 are designed to be worn during sleep and incorporate a silent vibrating alarm clock. (Nike, 2014; Fitbit, 2014; Jawbone, 2014)
Figure 5. Listed from the left; Nike+ Fuelband, Fitbit Flex, Jawbone UP24. (Nike, 2014; Fitbit, 2014;
Jawbone, 2014)
Later in the project, when the scope was narrowed down, different existing alarm systems were investigated, focusing on mobile wearable alarms. Ascom is a company that delivers different kinds of alarm systems for healthcare and they have one solution that was seen in a neighbouring care unit during the observations at Södersjukhuset. At the unit, the alarm was used in a similar way as the existing alarms at other care units visited. The main difference was that the nurses could receive alarms on a mobile device carried in the pocket of the uniform. (Ascom, 2014) TryggSenior is another mobile alarm meant to be used by elderly people. The design of the alarm is simple and it only has one single red button to press in an emergency. When the red button is pressed a speaker call automatically connects to the operator who organise what kind of help action is needed. (Familjelarm 1, 2014) Vega GPS larm is an alarm made especially for demented
